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Decriminalisation Under Attack: What Opponents Propose To Fix Drug Problems

While the first piece explored the framing, images and positions used to critique decriminalisation, this piece will focus on the solutions opponents are proposing.

 

1. Stigma is a positive force in society

Youtuber J.J. McCullough was somehow considered a key voice to comment on drug-related deaths by the Washington Post. In his piece, McCullough says that it is taboo to stigmatise drug use in Canada, when stigma is often an effective strategy to achieve other health-based objectives like reducing tobacco smoking. Countering decades of expert investigations into the barriers created by stigma, he states that judgement is an effective tool to tackle societal ills.

McCullough argues that, unless we bring stigma back into Canadian society, we risk normalising addiction, creating a society where “carnage and suffering that can be pitied or managed but never judged or fixed – because nothing is wrong”.

Nobody has stopped using drugs due to stigma. It’s widely understood that stigma impacts drug treatment outcomes, encourages discrimination of people with drug addiction and the idea that they are “dangerous”. Encouraging it is either misinformed, naïve, or ideological: it doubles-down on a strategy that has not worked for over half a century.

Even “positive stigma” in other health-related areas, like tobacco smoking, has been proven to be counterproductive. A systematic analysis of studies on smoking and self-stigma agreed that smoking prevalence could be reduced through stigma, but it also highlighted several unintended consequences, including guilt, loss of self-esteem, and actually strengthen people’s resolve to continue smoking. It also found that “fear of stigma can lead individuals to avoid treatment for a health condition”, which is commonly argued by harm reduction advocates as a consequence of drug-related stigma.

Interestingly, the study also found that there was a “downward comparison” effect between smoker groups: one group would apply negative stereotypes of smoking on another sub-group if they saw them as behaving worse than them. The first group would thus not internalise the negative stereotypes of smoking, but pass them downwards to the next subgroup that’s behaving in a “worse” way. And while it could be argued that some of these behaviours should be looked down upon (such as smoking around children), it goes to show how stigma can reproduce itself even within already-stigmatised groups.

The UN has highlighted how discrimination is healthcare settings can deny people access to health services, and encourage systems that subject people to involuntary treatment, deny their autonomous decision-making, or further criminalise people. With stigma being widely accepted within the medical field as being a barrier to drug treatment, it is dangerous to suggest stigmatisation as a policy. Not only does it discredit harm reduction interventions as “doing nothing”, but it also encourages a system that reproduces stigma between and within drug-using groups, further dividing and isolating them. Stigmatising people may have some cessation effects, but at the cost of further shaming people who use drugs, and perhaps even strengthening problematic drug use. This is a blunt approach to an issue that requires very incisive responses.

 

2. Replace decriminalisation with “smart enforcement”

Citing both the War on Drugs and harm reduction’s failure to reduce drug deaths, an alternative “third way” was forward by Blair Gibbs and Keith Humphreys. Gibbs is the former adviser to the disgraced British Prime Minister Boris Johnson, and past Volteface adviser. Humphreys is a former member of the White House’ Commission on Drug-Free Communities under President George W. Bush and Obama, an adviser to the UK Government under Boris Johnson, and the only addiction specialist quoted by the Globe and Mail and Washington Post.

This self-entitled “third way” on drug policy promotes a “smart enforcement”: an ill-defined approach to drug control which seems to be composed of court-mandated sobriety, and investments in recovery interventions. This stems from Humphreys’ and Gibbs’ belief that “pressuring addicted individuals to undergo treatment is controversial” yet necessary. They also mention the need to invest in opioid substitution medicine like buprenorphine and in recovery communities.

Doubling down on enforcing addiction treatment is supported by those interviewed in the other outlets: a cop interviewed by the NYT believes people aren’t willing to be treated by themselves; another NYT piece explores that some unnamed politicians and community groups who want Oregon’s decriminalisation approach to be replaced with tougher fentanyl possession laws.

Thankfully, very few articles examined encouraged a return to punishing people that use drugs. However, there were two noteworthy exceptions.

A perspective published by the Washington Post was written by someone who argues that his only path to drug recovery was through arrest and court-mandated drug treatment. Written by Michael Clune, a white professor of humanities who was previously arrested for heroin possession, he recounts that his arrest brought him relief; only his court-mandated treatment programme and the legal “stick” of mandated treatment helped him become abstinent.

Crucially, Clune never spent time in prison; it’s unclear whether he has a criminal record because of his drug use. And while he says he has “no wish to minimise the costs of incarceration or the abuse and suffering that many of us encounter in the criminal justice system”, he nonetheless encourages putting people through a criminal justice system that targets people of colour (already over-policed by drug laws), is known to have large, lasting and negative effects on people’s future employment opportunities and/or access to housing. These are all major factors that must be considered when encouraging mandated treatment, where the consequences of failure can be potentially life-altering.

The second, also published in the Washington Post, outlines a public letter signed by 18 American attorney generals calling for fentanyl to be classified as a “weapon of mass destruction”. This bodes well: the US has a successful history in correctly identifying and solving conflicts when weapons of mass destruction are involved. I don’t think much more needs to be said.

While it is true that there needs to be willingness from people to pursue treatment for it to be effective, compulsory drug treatment’s effectiveness is contested: a systematic review of compulsory treatment concluded that there is limited evidence of its efficacy, and that there are potentials for “human rights abuses” within these settings, as seen around the world.

As Maia Szalavitz extensively evidenced in her column, mandated treatment programs can often be “harsh, low qualityunderfundedunderstaffed and too often fraudulent.” Forced treatment appears to be a beautifully centrist mix of enforcement and therapy; but coercion can prevent the internal desire to change, a critical feature for long-term treatment success.

Rather than attempt something truly new, like motivating people into treatment with positive benefits (like housing, employment opportunities, life restructuring or other forms of support), the proposed “new” way just rebrands what has been done for decades: continue to criminalise drug use, and coerce people into treatment with the threat of incarceration.

The “smart enforcement” approach also does nothing to resolve a toxic drug supply, which is a key driver of lethal drug harms. It’s great to criticise decriminalisation and suggest treatment options, but people will continue to use drugs. Limiting measures solely to enforcement and treatment without exploring market-improving measures like drug consumption rooms, widespread drug testing and other harm reduction interventions is unnecessarily limiting the breadth of drug harm-reducing options available

The only wise thing about “smart enforcement” are the strategies already supported by harm reductionists. The third way authors support the use of buprenorphine, an opioid substitution medicine already championed by harm reductionists worldwide. Used alongside methadone, both of these treatments are an example of pragmatism and evidence-based solutions – core tenets of harm reduction.

We need to encourage pathways and risk assessments that determine what type of personalised intervention someone requires to address their specific needs, when they need it. Until then, let’s put measures in place to keep people alive.

3. Ultimately, a drug-free life

This will, in my opinion, forever be the ultimate disagreement between conservative and progressive supporters of decriminalisation. Where one side feels that drug use is not a crime or a moral failure, the other seeks to erase it due to its perceived destructive societal effects. Meanwhile the structural harms faced by people who use drugs were mostly ignored: barely any of the analysed pieces called for more housing, universal access to income or for governments to address inequality and social isolation.

In many of the pieces, there’s a conflation between all drug use, and problematic use. As Humphreys and Gibbs state in their “third way”, we need to transition people into a “drug-free life over time”.  Normalising drug use is equated to normalising drug addiction, as one inevitably leads into the other. This is reinforced by mentions of people’s brains “hijacked” by drugs, or zombified by them: we must wrestle control back from the drugs controlling someone.

As harm reduction advocates are not focused on eradicating drug use, they’re seen as apologists of drug addiction, and by proxy of drug cartels, dangerous dealers, and many other nefarious characters that allegedly want to destroy communities.

Many of these pieces seem to argue that North Americans gave harm reduction a full and honest go, and it has failed; some even reduce what’s is being built in Oregon as “only harm reduction”. What opponents to decriminalisation want now is innovative enforcement. This is a woeful misrepresentation: enforcement has been the dominant approach to drug control ever since “drug control” was conceived, and it has utterly failed at reducing drug harms.

Prohibition and its enforcement have been the dominant system for the past 60 years: in that time, they’ve generated countless drug wars, catalysed security crises around the world and poisoned the drug supply that is killing thousands today. While obvious, this seems like a much-needed reminder for those criticising deviations from prohibition.

Harm reduction has not only been a marginally accepted idea, it remains highly criminalised across North America: drug checking is restricted by American paraphernalia laws, with fentanyl testing strips still illegal in some states; American and Canadian activists risk arrest when setting up safe injection sites. The lack of funding for harm reduction has consistently delayed the implementation of life-saving initiatives, from the 1980s HIV epidemics until today. How many more lives would we have lost if harm reduction were not in place?

With Oregon being the first and only state to properly attempt all-out drug decriminalisation, we should support (true) innovative approach, giving it the time and resources to be done properly. Deploying a new drug system within the current toxic drug supply, and the historic lack of funding for harm reduction means that Oregon faces an uphill battle; but it is one not we can afford to lose.

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